Asking about if obesity is hereditary? Then, genes aren’t the most worrisome risk of obesity. An individual’s upbringing can be, the way the family raises, the daily food intake, importance placed on physical activity and how a person would take their behaviour model, are the bigger influences on likelihood of obesity than genes. Health is not valued till sickness comes, true isn’t? Obesity is not because it runs in the family!! It is because no one runs in the family!!!

Today, more than 95% of all chronic diseases is caused by food choice. Yes,being overweight is linked to a number of health and oral health diseases, including: heart disease, high blood pressure, diabetes, cancer, gallbladder and gallstones, breathing problems, such as sleep apnea (when a person stops breathing for a short time during sleep) and asthma, oral health problems such as caries, halitosis, poor oral hygiene, periodontal disease. Symptoms for obesity include breathlessness, Increased sweating, snoring, inability to cope with sudden physical activity, feeling tired, back and joint pain, low confidence and self-esteem, and feeling isolated.

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After being aware of the risks, proper health and oral hygiene should be maintained. And why is maintaining diet an important factor? Because a poor diet may result in lack of essential nutrients and vitamins thus potentially making it more difficult for your body to fight off an infection. A diet high in fat and calories, including large quantities of processed foods or sugar, and lack of physicalactivity, leads to obesity. Those same foods can cause oral health problems including gum disease, premature tooth loss and bad breath Our body craves for what is in our bloodstream. Wheat, sugar, alcohol, coffee and de-vitalized foods are designed to be addictive. Sugar being addictive – agreed. But how does sugar affect an individual’s health and oral health? Well, consuming sugar is bad for an individual, but consuming too much has become a norm and that can cause health issues. The only type of sugar the body needs is glucose, which it can make by breaking down carbohydrates, proteins and fats. When ingested, simple sugars are converted into plaque if not removed immediately. As plaque begins to accumulate on our teeth and gums, the risk of varying forms of gum diseases such a gingivitis and periodontitis, as well as tooth decay, may become inevitable.

In 2018, a study revealed that 170 children and young people have rotten teeth removed every day, undergoing general anaesthesia. That’s an unpleasant operation that is completely avoidable; we have got a lot of evidence to show that the main cause is excessive sugar. There are also links with type 2 diabetes, usually chronic disease seen in adults, but we are seeing more and more under the age of 25 these days.

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So, what an oral health care professional should be aware of? Dentists must be aware of how nutrition impacts general and oral health, and how dental treatment can impact patient’s nutritional status. Oral health is strongly influenced by the daily intake of food; on the other hand, oral health can also play a significant role in nutritional intake and general health status. The dental caries is also a chronic disease and may be depend on oral hygiene, high intake of sugar added to food, lifestyle factor, and host factors (salivary flow, buffer capacity and buccal microflora). Relationship between obesity and gum disease – we actually don’t know if this is a one-way or a two-way street. For example, conditions like diabetes, the relationship is bilateral. Periodontal disease will affect diabetes and diabetes will worsen periodontal disease, so that could be a possibility here. What are the other reasons of obesity affecting gums and what would be its risk factors? Because of various dietary habits and improper maintenance of oral hygiene, chronic periodontal infection is an inflammatory state that is described by a deviation in microbial environment and composition of subgingival plaque bio films and accelerated destruction of tooth supporting structures. Thus, low glycaemic diet may be beneficial to our oral health. Periodontal diseases are also influenced by various risk factors including aging, smoking, oral hygiene, socio-economic status, psycho social stress, osteopenia, osteoporosis and various systemic diseases, which signifies that periodontitis does not merely occur as a consequence of plaque deposition but is also coupled with various other host factors. Also, on examination, obese adolescents exhibited multiple carious teeth, higher plaque index, gingival inflammation, bleeding on probing and probing depth compared to normal weight subjects of similar age.

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An obese patient, whose lungs are often not large enough to lift heavy chest walls, can have trouble during breathing, especially when active. Also, during sleep the person might breathe through his/her mouth instead of nose, thus jaw is forced into an unnatural position for a longer period of time. This can lead to teeth grinding and development of an overbite, over jet or spacing between the anterior teeth.How can we, as dentists, help the obese patients? Dentists should include the evaluation of BMI in routine patient examination and eventually refer obese periodontal adolescents for weight reduction interventions like diet therapy, behavioural therapy, pharmacotherapy, so that they can have better control over periodontal inflammation.What are the practical considerations in dentistry? It can be difficult carrying out dental care for an obese patient: the maximum lifting weight for modern dental chair is approximately 140kg (23 stones). The position of anatomical landmarks may be less obvious if surrounded by fatty tissue, the landmarks for placement of an inferior alveolar nerve block can be impossible to palpate through excess soft tissue. It may be impossible to palpate cervical lymph nodes in a large neck. Also due to constant secretion of saliva, the mouth and teeth are rinsed and kept free off food debris and foreign particles, thus excess of buccal pad of fat hinders with self-cleansing action in the mouth. Because of lack of saliva present in the mouth, it can lead to dry mouth. Sip water frequently throughout the day and use alcohol-free antiseptic mouthwash daily for cure. A normal sized mirror is unsafe for retraction of soft tissues: a ‘lax’ tongue retractor can be useful.What is the alternative to conventional dental chair? Refer the patient to the hospital environment where the patient may be treated on an operating table or trolley. Another possible solution for obese patients is a custom-made chair such as DIACO dental chair. What is the difficulty faced during conscious sedation? When thinking about conscious sedation for obese patients, the potential difficulties in airway management and intravenous cannulation should be considered. The provision of inhalation sedation with nitrous oxide during which oxygen levels are maintained at or above 30% may be more appropriate. If intravenous sedation with midazolam is proposed, the overall benefit to the patient must be carefully weighed up against the increased likelihood of significant respiratory depression and the difficulties in managing a respiratory complication. New research suggests that the health of your mouth mirrors the condition of your body as a whole. A healthy smile can surely transform our visual appearance and the positivity of our mind-set.

‘Eat every two hours, sleep eight hours, have plenty of water and pray to keep calm. Most importantly, carry a smile on your face.’

About the author

Dr. Vishaj S. Maru is a dental surgeon. She studied dentistry at the D.Y. Patil School of Dentistry. She does clinical practice in Mumbai with a keen interest in academia and clinical dentistry.

1. Dates:

Regular intake of dates keep your body warm during winters

Regular intake of dates helps your body to stay warm during winters. It contains a lot of minerals, vitamins and health benefitting phytonutrients and most importantly they are easily digestible. The lower fat content present in dates helps you keep your weight in check. Dietary fiber (6% of daily nutritional value (DNV)) – Dates help move waste smoothly through your colon and help prevent LDL (bad) cholesterol absorption by binding with substances containing cancer-causing chemicals. Iron (1% DNV) – a component of hemoglobin in red blood cells, determines the balance of oxygen in the blood. Potassium (5% DNV) – an electrolyte, helps control your heart rate and blood pressure. B-vitamins contained in dates, such as the carotenes lutein and zeaxanthin, absorb into the retina to maintain optimal light-filtering functions and protect against macular degeneration. Vitamin A (1% DNV) – protects the eyes, maintains healthy skin and mucous membranes, and even protects the lungs and mouth from developing cancer. Tannins, which are flavonoids as well as polyphenolic antioxidants, fight infection and inflammation and help, prevent excessive bleeding (anti-hemorrhagic). Vitamin K is a blood coagulant that also helps metabolize your bones. Copper, magnesium, manganese, vitamin B6 (pyridoxine), niacin, pantothenic acid, and riboflavin are also present in dates and provide their own unique preventive and healing functions. Together, these cofactors help your body metabolize carbohydrates, protein, and fats. Eating dates in moderation can contribute to many health benefits, such as protecting against damage to cells from free radicals, help to prevent a stroke, coronary heart disease and the development of colon, prostate, breast, endometrial, lung, and pancreatic cancers.

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2. Cacao

Cacao best natural sources of antioxidants, iron, magnesium and zinc

Cacao is one of the best natural sources of antioxidants, iron, magnesium and zinc. Zinc is an important trace mineral important for better immune function. Anandamide which can naturally boost your mood & create a sense of elation; it can also boost serotonin levels in the brain which is another feel-good chemical, these chemicals can then boost brain calming hormones that can relax us if we are feeling stressed & restore feelings of well-being. Flavanols that boast anti-inflammatory health benefits as well as complex antioxidants also known as polyphenols. Flavanols & polyphenols can protect against cardiovascular disease, reduce the risk of stroke, improve blood circulation, reduce “bad” cholesterol & prevent hardening of arteries. Polyphenols antioxidants can also protect our cells from premature oxidation or destruction & help us look & feel younger for longer.

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3. Ginger

Ginger is a powerhouse root veggie that’s packed with medicinal qualities

Raw ginger root is used both in cooking and in herbal medicine. Ginger is a powerhouse root veggie that’s packed with medicinal qualities such as antimicrobial properties and anti-nausea benefits. Additionally, a chemical in ginger called Gingerol helps decrease inflammation and blocks nerve pathways that process pain. Consuming ginger may help limit nausea and motion sickness and may help treat arthritis by decreasing inflammation. It also contains small amounts of fiber, essential vitamins and minerals, but due to the small amount usually consumed in any given meal, it is unlikely to greatly affect your nutrient intake. Macro nutrients – one-fourth cup of ginger contains 19 calories, 0.2 grams of fat, 0.4 grams of protein and 4.3 grams of carbohydrate, including 0.5 grams of fiber. Higher consumption may cause heartburn,stomach upset and diarrhea and may interfere with certain medications, including blood thinners, diabetes medication and blood pressure medications. Vitamins – eating 1/4-cup of raw ginger would provide you with 2% of the daily value for both vitamin B-6 and vitamin C, as well as smaller amounts of niacin, riboflavin, folate, thiamine and vitamin E. Vitamin B-6 is necessary for metabolism, immune function and red blood cell function, and vitamin C is important for healing wounds and for limiting damage to your cells from free radicals. Minerals – while one-fourth cup of raw ginger only provides very small amounts of iron, calcium, phosphorus and zinc; it contains 3% of the DV for magnesium and potassium. Magnesium is used for metabolism, forming proteins and muscle and nerve function, and potassium helps lower blood pressure levels and maintain proper heart and digestive function.

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4. Spinach

Low in calories rich in minerals, vitamins, antioxidants and omega 3 fatty acids

Spinach’s nutritional value indicates that it is extremely nutrient dense. It is low in calories yet rich in minerals, vitamins, antioxidants and omega 3 fatty acids. Spinach is also loaded with flavonoids which act as antioxidants and can protect the body from free radicals which is an essential health benefit all year round, but especially during winter when we are more likely to catch cold or flu. The iron rich food can also improve energy levels as iron is an important component of haemoglobin which transports oxygen to the body cells.

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5. Carrot

This crunchy veggie carries vitamin C, vitamin K, folate, iron, and potassium, all of which are important for fighting off germs during cold and flu season

This root vegetable contains high amounts of beta carotene which the body converts into vitamin A. Vitamin A is a key nutrient in the immune function, helping to protect against infection and reduce the risk and duration of respiratory illness by keeping our lungs healthy. It is an excellent food to protect the skin from ageing. Carrots also contain loads of vitamin A for healthy eyes, on top of fiber for good digestion. Plus, this crunchy veggie carries vitamin C, vitamin K, folate, iron, and potassium, all of which are important for fighting off germs during cold and flu season.

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6. Pomegranate

Pomegranate may have heart health benefits by improving your cholesterol profile and protecting LDL (bad) cholesterol from oxidation

Pomegranates are rich in vitamin C and contain folate, vitamin K and potassium. There is some research to suggest that pomegranate may have to heart health benefits by improving your cholesterol profile and protecting LDL (bad) cholesterol from oxidation.

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7. Cinnamon

Ground cinnamon is a good source of calcium and iron

Ground cinnamon is a good source of calcium and iron, which are required for good immunity and maintaining healthy red blood cell production. Research suggests this spice may also help to lower blood sugar levels.

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About the author

Nidhi Dhawan is a dietitian with experience of 21 years in the field. Ms. Dhawan practices at Diet Zone, Delhi. With BSc in Home Science from Lady Irwin college, DDPHN from IHE, Delhi and Diploma in Preventive & Promotive Healthcare from Apollo Hospitals, she is a lifetime member of Indian Dietetic Association. Her expertise is therapeutic diets like chronic kidney disease, coronary artery disease, chronic obstructive pulmonary disease, polycystic ovary disorder, diabetes type 1 and 2, chronic liver disease, jaundice, weight management, kids and infants nutrition etc.